不同检查方法对恶性阻塞性黄疸的评估及诊断价值

Value of different examination methods for evaluation and diagnosis of malignant obstructive jaundice

目的比较B超、CT、MRCP、ERCP及肿瘤标记物检查对恶性阻塞性黄疸的评估价值。方法回顾性分析112例确诊为恶性阻塞性黄疸病人的病例,分别比较B超、CT、MRCP、ERCP及肿瘤标记物在这些病例中运用的情况及对恶性阻黄的病因判断、定位诊断和手术方式选择的价值。结果B超、CT、MRCP、ERCP及肿瘤标记物的运用率分别为100.0%、94.6%、83.0%、33.9%及40.2%,对病因判断的正确率为86.6%、91.5%、93.5%、97.3%、77.8%,对恶性阻黄的定位正确率为92.8%、89.7%、97.8%、94.7%。MRCP、ERCP对于手术方式的选择最有价值,肿瘤标记物+B超检查及B超+CT+MRCP检查正确率大于单用一种方法。结论B超和CT可作为疑诊为恶性阻黄的初选方法,肿瘤标记物的检查可提高阻黄判断的正确率,MRCP和ERCP对恶性阻黄的定位及病因评估价值最高。对恶性阻黄的术前评估应配合各项检查,循证决策。

Objective To determine the value of B-mode ultrasonography, CT, MRCP, ERCP and tumor marker detection for evaluation and diagnosis of malignant obstructive jaundice （MOJ）. Methods The clinical data of 112 patients with confirmed MOJ were retrospectively analyzed to compare the use and judgment of etiological factors and value of B-mode ultrasonograpy, CT, MRCP, ER CP and tumor marker detection. Results The rate of application was 100. 0%, 94.6%, 83.0%, 33.9% and 40. 2% for B-mode ultrasonography, CT, MRCP, ERCP and tumor marker detection, respectively. Meanwhile, the rate of precision in etiological factor judgment was 86.6%, 91.5%, 93.5%, 97.3% and 77.8% while the rate of localization precision was 92.8%, 89.7%, 97.8% and 94.7% by B-mode ultrasonography, CT, MRCP, ERCP and tumor marker detection, respectively. MRCP and ERCP were the best means for selection of operative approaches. The precision rate by tumor marker detection plus B-mode ultrasonography or B-mode ultrasonography plus CT and ERCP was higher than that by simple ways. Conclusions B-mode ultrasonography and CT can be used as the initial methods for screening of suspected MOJ and tumor marker detection can increase the precision rate of diagnosis. MRCP and ERCP are very useful for localizing and judging the etiological factors. It is better to combine all these methods for evaluation before operation.